Individual
DR. ADALBERTO R FONTICIELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 WEST KINGSHIGHWAY, SUITE 12, PARAGOULD, AR 72450-8894
(870) 236-6930
(870) 239-8065
Mailing address
1000 W KINGSHIGHWAY, SUITE 12, PARAGOULD, AR 72450-4141
(870) 236-6930
(870) 239-8065
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
C-6766
AR
208600000X
Surgery Physician
C-6766
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157456002
—
AR
Enumeration date
01/20/2006
Last updated
03/20/2020
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